Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

Patel, Nishant; Weiss, Eric S.; Nwakanma, Lois U.; Russell, Stuart D.; Baumgartner, William A.; Shah, Ashish S.; Conte, John V.

doi:10.1161/circulationaha.107.756866

Cited by 121 publications

(75 citation statements)

References 17 publications

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“…Organ preservation and cardiopulmonary bypass also have deleterious effects on ventricular function [22][23][24] . The previous common practice of using oversized donors for recipients with PH has been found unnecessary 25 . Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Bedáňová

Orban²,

Vrsanský³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims.To determine the effect of pre-existing pulmonary hypertension (PHT) on early hemodynamics, morbidity and mortality after heart transplantation (HTx). Methods. Data were prospectively collected from 149 patients, who underwent HTx between January 2000 and December 2007. The subjects were divided into 3 groups: Group A (n=84) without PTH, group B (n=50) with mild to moderate PTH and group C (n=15) with severe PTH. We studied hemodynamic profile, tricuspid valve regurgitation (TR), incidence of acute cellular rejections (AR), infections, duration of hospitalization, 30-day mortality and a longterm survival. Results. Baseline characteristics were similar in all groups. Using vasodilator treatment PVR was successfully brought down to normal range 2.5 ± 0.6 Wood' units (WU) on the day 1 following the surgery in all groups. Over 80% of patients were treated in Group C, 32% in Group A and 46% in Group B. There was no significant difference in the severity of TR among the 3 groups early after HTx (severe TR was observed in 46%, 54%, 33%, respectively). There was no significant difference in incidence of AR (G ≥ 2 Banff classification) (23%, 23%, 33%, respectively), infections (28%, 32%, 33%, respectively) or duration of hospitalization (30, 30, 28 days, respectively). There was no correlation between pre-transplant PHT and 30-day mortality or a long-term survival. Conclusions. In our cohort, PHT dropped very quickly after HTx, and was not associated with acute right heart failure following the surgery. Reversible PTH does not have a negative impact on short-or long-term survival after HTx.

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Section: Discussionmentioning

confidence: 99%

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Bedáňová

Orban²,

Vrsanský³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…6 For the recipient, age, body mass index, high preoperative creatinine level, ischemic time, cardiovascular diseases or hematologic-associated causes, and the patient's psychological state can affect survival. 2,[7][8][9][10] For the donor, higher age, donor diabetes mellitus history, and sex mismatch or race mismatch can increase the recipients' mortality after heart transplant. 9,11 The principal causes of death after this procedure include cardiac graft vasculopathy, primary graft failure, graft rejection, infection, and neoplasia.…”

Section: Introductionmentioning

confidence: 99%

“…2,7-10 For the donor, higher age, donor diabetes mellitus history, and sex mismatch or race mismatch can increase the recipients' mortality after heart transplant. 9,11 The principal causes of death after this procedure include cardiac graft vasculopathy, primary graft failure, graft rejection, infection, and neoplasia. 12,13 In recent years, new developments to minimize the causes of death have been implemented, thus raising survival rates.…”

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confidence: 99%

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Rojas¹,

Cruz-Ku²,

Yassen³

et al. 2018

Exp Clin Transplant

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Objectives: The identification of variables related to the survival of heart transplant patients is vital for a good medical practice. Few studies have examined this issue in a Latin American population. Therefore, the aim of this study was to analyze, retrospectively, the survival and mortality characteristics of patients after heart transplant. Materials and Methods: Information on patients was obtained through review of medical records; we collected information on all patients who underwent this procedure from 2010 to 2015. Sociodemographic, clinical, and surgical characteristics associated with posttransplant mortality were analyzed. Survival over 5 years was determined with the Kaplan-Meier method. Results: The overall survival rate of the 35 patients who underwent heart transplant was 85%. Those with low total cholesterol values (< 160 mg/dL) had a lower survival at 5 years than patients with higher values (74% vs 100%; P = .044). The overall mortality was 14.3%, and the main cause of death was acute graft rejection (40%). Lower total cholesterol level (< 160 mg/dL; P = .036), presence of chronic kidney disease stage 1 (P = .049), intraoperative bleeding (> 600 mL; P = .013), and number of sepsis incidents (P = .03) were more frequent in patients who died. Conclusions: The survival in our institute at 5 years is higher than shown in the reported literature, and the mortality is lower. In addition, a low total cholesterol value negatively affects survival of heart transplant patients at 5 years. Key words: Cardiac surgery, Cholesterol, Graft rejection, Sepsis IntroductionCompared with past decades, the International Society for Heart and Lung Transplantation and other institutions have recorded improved survival after heart transplant at 1, 5, and 10 years. 1,2 This is relevant because this surgical procedure remains the treatment of choice in patients with severe heart failure from different causes. 3 Data have also demonstrated survival greater than 20 years after heart transplant. 4 However, survival continues to be below 80% at 5 years in various institutions. 2,5 Survival after heart transplant is affected by several mortality factors from both the recipient and the donor. 6 For the recipient, age, body mass index, high preoperative creatinine level, ischemic time, cardiovascular diseases or hematologic-associated causes, and the patient's psychological state can affect survival. 2,7-10 For the donor, higher age, donor diabetes mellitus history, and sex mismatch or race mismatch can increase the recipients' mortality after heart transplant. 9,11 The principal causes of death after this procedure include cardiac graft vasculopathy, primary graft failure, graft rejection, infection, and neoplasia. 12,13 In recent years, new developments to minimize the causes of death have been implemented, thus raising survival rates. 14 These include the implementation of more protocols, strict sanitary policies, and the combination and use of better immunosuppressive therapy. 6 Most studies have been done on p...

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“…According to the 2014 SRTR and OPTN annual data report, of candidates listed in 2011, 55.9% underwent transplant during the first year on the waiting list, 30.2% were still waiting, and 7.2% had died. At 3 years, 9.2% had died, 12.6% had been removed from the list, 68.6% had undergone transplant, and 9.5% were still waiting. 2 Thus, all efforts should be made in order to maximize the success rate; among these a proper match between the recipient and the donor is of major importance.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Similarly, data regarding the effect of gender matching on survival are conflicting, possibly because of inconsistent assessment of the risk for early and late mortality in previous studies. 1,[3][4][5][6][8][9][10][11][12][13][14] Accordingly, in the present study we aimed to comprehensively investigate the impact of gender matching on early and late outcomes following HT including a comprehensive analysis of the long-term rejection process among patients enrolled in the Sheba Medical Center (SMC) HT Registry.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Gender Mismatching on Early and Late Outcomes Following Heart Transplantation

Peled

Lavee

Arad

et al. 2016

The Journal of Heart and Lung Transplantation

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Aims The role of donor/recipient gender matching on the long-term rejection process and clinical outcomes following heart transplantation (HT) outcomes is still controversial. We aim to investigate the impact of gender matching on early and long-term outcome HT. Methods and resultsThe study population comprised 166 patients who underwent HT between 1991 and 2013 and were prospectively followed up in a tertiary referral centre. Early and late outcomes were assessed by the type of donor-recipient gender match (primary analysis: female donor-male recipient [FD-MR, n = 36] vs. male donor-male recipient [MD-MR, n = 109]). Early mortality, need for inotropic support, length of hospital stay, and major perioperative adverse events did not differ between the FD-MR and MD-MR groups. However, the FD-MR group experienced significantly higher rates of early major rejections per patient as compared with the MD-MR group (1.2 ± 1.6 vs. 0.4 ± 0.8; P = 0.001), higher rates of overall major rejections (16 vs. 5.5 per 100 person years; P < 0.05), and higher rate of cardiac allograft vasculopathy (43% vs. 20%; P = 0.01). Kaplan-Meier survival analysis showed that the cumulative probabilities of survival free of rejections and major adverse events were significantly higher in MD-MR group (P = 0.002 and 0.001, respectively). Multivariate analysis showed that FD-MR status was associated with >2.5-fold (P = 0.03) increase in the risk for rejections and with a >3-fold (P = 0.01) increase in the risk for major adverse events during follow-up.Conclusions Donor-recipient gender mismatch is a powerful independent predictor of early and late rejections and long-term major adverse events following HT.

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Impact of Donor-to-Recipient Weight Ratio on Survival After Heart Transplantation

Cited by 121 publications

References 17 publications

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

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The Impact of Gender Mismatching on Early and Late Outcomes Following Heart Transplantation

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